Hypothyroid and Type 1 Diabetes

nurseprnRN, BSN, RN · Apr 23, 2012

remember that thyroid is the main driver of the metabolism bus, and that glucose is the main fuel for that bus. does that help get you moving in the right direction?

guest042302019, BSN, RN · Apr 24, 2012

We have two metabolic diseases here. Type 1 Diabetes and Hypothyroidism. To effectively understand the medications, one should start from the basics. Understanding the basic functioning of the two organs. As we know, pancreas produce insulin and thyroid gland produces T3 (triodothyronine) and T4 (thyroxine). Of course, there are other functions as well for each organ these functions are the focus. Insulin promote cellular uptake of glucose to be available to create ATP. And, the thyroid hormones promotes the cell to effectively use O2 and glucose to create energy. It's like this. Insulin supplies the parts of the end product of energy. And, the thyroid hormone helps create the end product of energy. Anyway.

Let's consider the patient with Type 1 Diabetes and Hypothyroidism

Type 1 Diabetes -------> no insulin production/secretion -------> no cellular uptake of glucose -----> decreased ATP production

Hypothyroidism --------> impaired T3/T4 production ---------> impaired cellular usage of O2/glucose ------> decreased ATP production

With that in mind, let's consider your question. How does levothyroxine affect blood sugar? Well, we can see that if we replace T4, we will probably see a more efficient usage of O2/glucose. With a more efficient usage, we would see more ATP (energy) production and ultimately, a more efficient metabolism. A patient would be less lethargic or tired because the cells are creating energy more efficiently and likely, in larger quantities. Would we see a change in blood sugar? Possibly. If a patient is using the sugars more effectively, we may see a decrease in theory. I'm not really sure about this though. You may have to find the answer in your research.

Your other question. Would levothyroxine affect the metabolism of insulin? If you notice from above, insulin and levothyroxine are two separate entities but working on the same issue. Energy production. Do you mean, "will levothyroxine affect the action of insulin?" Again, I'm not sure. When we give levothyroxine, we are replacing what should normally be one's body. I'm not sure about the specific interactions between the two. But, I do know that each are working on the same issue but in a different manner.

You could ask your nursing instructors about the two. I would be interested in learning about the interactions. I hope this clears it up for you a bit. Good Luck!

Ted's Wife · Apr 24, 2012

The main issue is that this patient doesn't always take the Levo exactly as prescribed. Sometimes it's taken with food and/or milk, which is contraindicated. Sometimes a pill is missed.

I understand that the Levo and Insulin are working on the same issue. What I'm mostly concerned with, and I should've been more specific before, is how to get her sugar under control if the thyroid isn't. So that led to the question of how much the Levo actually affects the insulin.

I appreciate the responses!!

nurseprnRN, BSN, RN · Apr 24, 2012

the thyroid drives the metabolism (and if she's skipping it sometimes, metabolism will slow). when the metabolism is driven harder, it needs more fuel delivered to the cells. therefore, more insulin is needed to bring down blood glucose and put it into the cells where it's needed. if she's jacking both of these meds up and down, one chasing the other, equilibrium and therefore health is going to be elusive.

Ted's Wife · Apr 26, 2012

Thank you for the clarification.

So skipping the medication will cause changes in how her insulin works from day to day. Considering that the insulin calculation is being done properly at each meal and at bedtime, the fluctuations in her blood sugar could be attributed to her Levo...or lack thereof.